Medicare and Medicaid would let specialized nurses direct certain care

Nurse practitioners would be allowed to direct Medicare hospital care and supervise nursing-facility care under Medicare and Medicaid. These roles would cover Medicare hospital patients and nursing-facility residents covered by Medicare or Medicaid. The Medicare hospital-care and nursing-facility supervision roles would require nurse practitioners to follow state law. These provisions would apply to services furnished on or after the date 90 days after enactment.

Medicare would be barred from requiring physician supervision of certified registered nurse anesthetists. The rules concern certified registered nurse anesthetists, who are nurses trained to give anesthesia. Medicare Part B would pay for services ordered, certified, or referred by nurse anesthetists when state law allows them to take those actions. The service rules would apply to services furnished on or after the date 90 days after enactment. Federal health officials would have three months after enactment to revise the ordering and payment rules.

State Medicaid programs would cover nurse-anesthetist services and follow a minimum payment rule. The requirements concern services furnished to Medicaid patients by certified registered nurse anesthetists. Coverage would apply to services the nurse anesthetist is authorized to perform under state law. The requirements would apply to services furnished on or after the date 90 days after enactment.

Medicare would cover eligible trainee care supervised by certified nurse-midwives and require nurse-midwives to hold the specified professional certification. These Medicare rules concern nurse-midwives and interns or residents they supervise. Trainee services would have to fall within the nurse-midwife’s state-authorized work. The services must qualify for coverage both if furnished by a nurse-midwife and if furnished under physician supervision. Certification by a successor to the American Midwifery Certification Board would also qualify. These provisions would apply to services furnished on or after the date 90 days after enactment.

Medicare contractors would disclose experts and sources behind local coverage decisions and could not impose coverage limits based on covered clinicians’ qualifications. These rules would cover contractors that decide which services Medicare covers in their area. The ban on qualification-based limits would cover doctors and other health professionals listed in the referenced Medicare law. Each failure to follow the disclosure requirements or the ban could bring a fine of up to $10,000. These rules would apply to local coverage decisions posted on both the contractor’s and Medicare’s websites on or after enactment.